Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Impact Of Transplant Community Health Workers On Waitlisting And Living Donor Transplantation For End-stage Kidney Disease Patients
Judith
Eguzoikpe
, MD,MPH
, Transplant Liaison
, DaVita Kidney Care
The Challenge
Patients with End-Stage Kidney Disease (ESKD), particularly those eligible for the End-Stage Kidney Disease Treatment Choice (ETC) model and dual-eligible (DE) patients, face persistent barriers to transplantation. Disparities exist along the transplant continuum, from referral and evaluation to waitlisting and living donor identification. While prior studies have highlighted these inequities, effective interventions to support patients through this process remain limited.
The Approach
This hybrid prospective-retrospective study involved six transplant centers. Four culturally concordant Transplant Liaisons (TLs) from the Transplant Liaison Program conducted structured interviews with patients and caregivers, identified barriers, and provided targeted education, advocacy, and coordination with transplant centers. Interventions included in-person and virtual education sessions, individualized action plans, navigation of transplant testing, and linkage to supportive resources. Outcomes for intervention patients were compared to matched historical controls using propensity score methods. Primary endpoints included waitlist activation, time from referral to activation, living donor identification, and completed living donor transplants.
The Results
28 dialysis units under the ETC model were identified, with 290 DE patients who were referred to transplant, in-workup, or inactive on the waitlist. Patients were 43% female; 80% Black, 10% White, 3% Hispanic/Latino, and 1.5% Asian; mean age was 56 years with an average of 6.2 years on hemodialysis. TLs identified key barriers to activation: unclear communication between center and patient (29.7%), difficulty completing medical testing (14.8%), low patient motivation to complete evaluation (18.7%), and limited understanding of the transplant process (14.2%). Among the 290 patients, 12 were activated (mean 80 days), 3 were waitlisted from referral (mean 60 days), and 14 received transplants (mean 100 days). Regarding living donation, 30% more patients expressed interest, and 10 patients were actively pursuing living donor evaluation.
The Transplant Liaison Program may effectively address inequities in kidney transplantation and optimize outcomes for ETC and DE patients. This approach deepens understanding of patient-level barriers and identifies actionable pathways to improve waitlisting, transplantation, and living donation among socially disadvantaged populations.
Insights & Lessons Learned
The findings of this study have direct implications for the professional practice of transplant clinicians, administrators, coordinators, social workers, and quality improvement leaders engaged in clinical operations. The Transplant Liaison (TL) Program demonstrates a scalable, operations-focused intervention that addresses persistent inefficiencies and inequities across the kidney transplant continuum, particularly for ETC-aligned and dual-eligible populations.
From a clinical operations perspective, the TL model enhances care coordination, workflow efficiency, and patient throughput by bridging gaps between dialysis units, patients, caregivers, and transplant centers. By identifying and mitigating operational barriers such as unclear communication, fragmented testing processes, and delays in evaluation completion, TLs function as an extension of the transplant team and reduce downstream burden on transplant coordinators and providers.
For transplant professionals, the program reinforces the value of standardized, patient-centered navigation embedded within routine operations. The use of culturally concordant liaisons improves patient engagement and trust, contributing to improved referral-to-activation timelines, increased living donor interest, and measurable gains in waitlisting and transplantation outcomes. These improvements align with quality benchmarks, regulatory expectations, and value-based care initiatives, including performance metrics tied to the ETC model.
This work is highly relevant to the clinical operations award category, demonstrating how a targeted navigation model can be integrated into existing workflows to improve efficiency, equity, and outcomes in kidney transplantation.